Nkululeko

It's early on a Tuesday morning.  My internet connection has been off and on, so with luck this posting attempt will work.  We went for a stunning hike on Sunday, encountering a herd of eland that included an enormous male (supposedly they can weigh up to 700 kg) and several babies in groups.  Also came fairly close to a Rinkhals, a poisonous snake.

The hike was to the Pinnacles, pictured above.  It was so quiet there.  I napped in the shade of the tallest rock.

Work has been quite challenging.  This is my second week in the "OPD," which is emergency, urgent care and chronic illness clinic wrapped into one.  Yesterday's two big themes were sick babies and nasty fractures.  There's no X-ray or transportation on the weekend, so every Monday morning there's an accumulation of patients that've gotten sick over the weekend or have waited for X-rays of their fractures.  I admitted five babies to the hospital.  For the fractures, thank goodness for the orthopedists where we refer (Edendale).  I must've called them eight times yesterday for help with fracture management, and they agreed to see everyone that needed it.  The patients seem incredibly stoic -- for example sleeping in a chair for 2-3 nights with a fracture waiting for an X-ray, and living with a great deal of pain. 

The work week started off yesterday with a lady lying on a mat on the floor dying of disseminated Kaposi's sarcoma.  She'd been there overnight because there was no open bed in the hospital.  Her sister was with her, and told me how beautiful and light-complected she had been, pointing to my skin and to her sister's skin. 

Triaging here is different than I could've imagined.  I understood rationally that this a place in crisis with a great deal of physical human suffering, and that is one of the reasons I came here -- because I can help to some degree.  Yet actually being with those who are so ill and in so much pain, and not having time or resources to help them is quite baffling and sad at times. The sickest patients often have disseminated infections.  If we can get an IV in them, we can give fluids and antibiotics, but several are already crossing death's threshold, and how long do you try when 30 other people are waiting for you to see them and the pharmacy closes at 4 p.m.?  So far I haven't found enough human or material resources to do effective advanced life support.   I must realize again and again that I am in the middle of an epidemic that is thousands of times bigger than my reach.  And realize also that there are situations every day where I can make a difference for individual patients.

I've met several men and boys named Nkululeko, which means freedom.  The people I meet have so much more in life than pain and suffering.  Freedom is here too, and love and joy.  We cannot lose sight of how much there is to being alive.